Cultural Competencies Assignment Paper

Cultural Competencies Assignment Paper

Cultural Competencies Assignment Paper

Various issues impact the quality of healthcare delivery within the healthcare system. One of these issues is cultural diversity. Healthcare organization strives to offer competent care to all people from diverse backgrounds (Henderson et al., 2018). Studies have so far contended that the inclusion of diversity in healthcare has effectively assisted in meeting patients need. The need to improve care for all patients has compelled healthcare organizations to hire competent healthcare workers from diverse backgrounds. The diverse nature of the human resource in healthcare has led to increased adherence to cultural competence. One of the reasons that compel healthcare organizations to adhere to cultural competence is the need to deliver effective care and increase the quality of care to patients with diverse beliefs, attitudes, and values. Practicing cultural competence requires a system that can personalize healthcare regarding linguistic and cultural differences (Henderson et al., 2018). Again, it requires an understanding of the potential effect that cultural differences have on healthcare delivery. Therefore, the purpose of this assignment is to reflect on my cultural competence and analyze ways of improving my cultural competence. Later, the study will analyze the relationship between culture, leadership, and teamwork and explore the ways communication can be muddled due to cultural differences

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Cultural Competence Self Reflection

Culture for diversity is an organizational culture that identifies, esteems, and values all cultures and assimilates those values into the system (Leggett & Price, 2020). A culturally competent organization can address the needs of varied groups of people. For instance, a culturally relevant organization monitors the demographics of the community they serve after a specific period to track the diversity in gender, race, and ethnicity and use the information to determine the strategic planning and outreach arrangement

Results on Cultural Competence
My score for cultural diversity is 49, which is interpreted as an average range on issues related to cultural diversity. An average score from the questionnaire shows that I am moderately interested in including out-group members in the group. Although I might be showing notable interest in including them, I do not make out-group members a concern on my priority list. For instance, if I get the chance to exclude out-group members, I would readily accept that chance and abandon out-group members. I always think that the out-group members have brought their out-group behaviors among themselves, thus supporting my decision of not including them in my lead. However, I would probably work with them if they sought to join my group.

My score surprised me because it referred to the ultimate truth about me. On most occasions have always limited my interaction with a diverse group as I believe that they would limit my choice of words and explanation on certain aspects. However, I have been denying this fact because I find myself working well with diverse groups and realizing an outcome I could not expect. The results have revealed an improvement in my relationship with out-group members because if I depended on the earlier perception about out-group members, it would be a worse scenario. Despite my recent relationship with the out-group members, I have failed to meet the overall threshold that could rate me as highly interested in including the out-group members on my team. These results further show that I need to realize the importance of workplace diversity and find it a habit of including out-group members on my team. I should be moving from the score of 49 to either 56 or 70. The high scores would show that I have constantly worked on improving my diversity skills among team members.

Ways of Improving My Cultural Diversity Skills
One of the ways to improve my diversity skills is by interacting more with diverse groups. Fixing myself to working with people from the diverse group would help me learn the beauty of diversity. The interaction with people from diverse groups would not only allow me to learn the ways of operation of other cultures but also appreciate their beliefs in association with the common goal (Leggett & Price, 2020). The interaction would as well improve my communication skills with other people and make it possible to work together to meet the desired goal. One of the issues limiting me from interacting with people from diverse backgrounds is ways of communication. Sometimes I feel that my choice of words is not significant in developing an effective relationship with such a team. However, through the constant interaction with the team, I am able to find ways of managing my emotions by incorporating the feelings of other people in my team. This would as well develop a common interest within my team.
Another way of improving my cultural diversity skills is by attending diversity-focused conferences. These conferences can evaluate the cultural and ethnic diversity of the people they serve to enable the recognition of the needs of cultural diversity within a health organization (Rissel et al., 2022). This training would also inform me of the latest research on cultural diversity. In this training, I would understand how the recent scientific world is aligning with cultural diversity. Again, they would equip me with the necessary skills on how modern science can impact diverse communities that have been marginalized in the past. The need for exposure to cultural diversity would not only expand my thinking on the topic but also change my behavior on culturally related issues. The training is meant to move my score from an average to a high one.

The development of my cultural competence skills would have a positive impact on my career and future relationships with people. For example, I will be able to launch several diversity initiatives in my organization. First, I would ensure that the organization has a diverse committee consisting of fifteen members whose primary function is to situate a strategy and evaluate its achievements (Rissel et al., 2022). Besides, I will enroll in programs for mentoring minority women professionals and appreciate the need for a diverse human workforce. The main of will be to enlarge the pool of qualified talent for superior stature positions historically closed due to the lack of knowledge of career prospects. Also, the organization has ensured that each employee undergoes diversity and cultural competency training to promote a culturally proficient culture.

My cultural competence skills would also play a significant role in managing a diverse workforce. The goal of any leader is to streamline the workforce and allow them uniquely perform their duties. This objective could only be achieved by enhancing team diversity. Managing a diverse workforce can be challenging but an essential skill for every nurse leader and in the entire healthcare sector (Rissel et al., 2022). I will be able to establish this by focusing on three critical things in my area. The first thing is to connect with diverse employees. A culturally competent nurse leader needs to connect with his workforce to determine what inspires them and engage each nurse by availing the information they need in the best way possible. Another initiative I would adopt creative collaboration (Rissel et al., 2022). This would include building a cohesive team that entails the institution of innovative partnerships that address gender, generational characteristics, and ethnic diversity. For the last initiative, I would apply constant communication to get necessary feedback and provide insights to junior nurses where appropriate. These measures would be imperative in meeting the desired goal and improving my skills in cultural diversity.

Analysis of Culture, Leadership, and Teamwork

A competent provision of patient care is one of the themes that have dominated the healthcare sector worldwide. All healthcare organization structures their goals around meeting a positive patient outcome. The implication is that there have been efforts by stakeholders to formulate the framework and offer the foundation upon which nurses can offer quality nursing care for everyone (Ahmed et al., 2018). One of such efforts is providing an appropriate environment that can enhance cultural diversity, support effective leadership and build a team focused on meeting the desired goals of the patients. Culture is related to various issues affecting the quality-of-service delivery required in healthcare organizations. Organizations that can build their leadership around culture are able to solve more healthcare issues and heighten the quality-of-service delivery.

Relationship Between Cultural Competence, Teamwork, and Collaboration

The diversity among healthcare providers and patients can affect communication in one way or another. This could also affect decisions made by clinicians and patients concerning treatment. While cultural competence affects how healthcare providers treat their patients, it could also define the poor interpretation of emotions that would result in poor patient treatment (Ahmed et al., 2018). For instance, a healthcare professional may interpret a patient’s silence as their lack of interest in receiving a particular treatment or care. In such cases, the healthcare professional may not order any diagnostic test on the patient that could result in a patient complication. Such thinking may erupt while, in the real sense, the patient’s silence shows their sign of respect to healthcare workers. In this case, the clinician would treat the patient unfairly because they failed to understand the patient’s cultural beliefs.

When healthcare professionals fail to understand the cultural differences between them and patients, they would inadvertently deliver poor care. The low-quality care would affect the entire healthcare delivery at the institution as its services would be branded as poor (Ahmed et al., 2018). Again, the increase in such cases would affect the good name of a healthcare organization affecting its productivity or significance within the community. Instead of patients choosing the clinic as their choice, they would seek other services from other healthcare organizations that can provide the quality they need. These are some of the current issues affecting the management of healthcare organizations recently, as many healthcare professionals perform poorly on cultural competence. While it might seem a less important issue among healthcare providers, it could be the source of failure of healthcare organizations (Shepherd et al., 2019). Therefore, cultivating skills that can improve cross-cultural communication is essential in delivering equitable care.

Building an effective team among healthcare professionals requires skills in cultural competence. The current healthcare organization has been able to mix their employees such that all races form part of the healthcare professionals. In a multi-ethnic environment, an effective team creates a good relationship with all healthcare professionals. Building a team with clinicians who reflect the diversity of patients they serve can also be significant in developing cross-cultural communication (Shepherd et al., 2019). The teamwork developed in healthcare support sharing of skills in healthcare that further aid in improving patient outcome. Such teams have the habit of consulting and working together to meet a common patient outcome. For instance, a diverse team tends to have a wide base of cultural knowledge that they share among themselves and can respond to patients with empathy to meet their unique needs.

A developed team in healthcare understands that the world has diverse people with diverse understanding and behaviors. These diversity factors have made cultural competence an important thing in the means of communication and collaboration in different working environments. Teamwork and collaboration are essential tools that aid people in learning how to respect, communicate, cooperate and work in a diverse culture (Shepherd et al., 2019). One of the importance of a united team in healthcare is that it increases appreciation for other perspectives. A united team is more open to various opinions from members, which in turn improves employee performance. A collaborative team would inspire each member to meet the desired goal, and they do not support an individual struggle but support unity in delivery (Ahmed et al., 2018). Such professionals would register high performance within their team as they feel a sense of motivation working as a team. Such teams can derive more ideas that make finding the solution to various issues affecting the healthcare system easier.

Cultural Awareness, Cultural Knowledge, Cultural Competence, and Cultural Sensitivity

Cultural awareness is the ability of a person to perceive their cultural beliefs, customs, and values and to understand that culture shapes behavior and decision (Nair & Adetayo, 2019). Cultural awareness has constantly been used in increasing patient safety in healthcare. Offering culturally competent care has increased significantly in recent healthcare as many patients feel such care meets their expectation of quality in treatment. The demand for offering culturally competent care has also revolutionized the nursing discipline through the emergence of culturally competent nurses. These nurses have effective training to offer patients unique and culturally aligned care (Nair & Adetayo, 2019). Cultural awareness increases patient participation and engagement, fostering respect and understanding among patients and clinicians. Improved relationship between patients and healthcare workers also leads to patient safety.

Cultural knowledge is the ability of an individual to understand various cultural characteristics, values, beliefs, history, and behavior of another ethnic and cultural group. These people are interested in learning about another culture and would go to the extent of living with a particular community to understand their culture (Nair & Adetayo, 2019). Cultural knowledge is important in the healthcare setting as it aids in breaking down cultural barriers and building bridges by learning ways of respecting and appreciating people of a different culture. A leader with cultural knowledge would effectively lead their team towards meeting the desired outcome. As such, leaders learn more about their culture than other cultures, and they learn to relate better with people from diverse backgrounds.

Cultural competence is the ability to understand, appreciate and relate with people from a different culture. Such people support the belief system of other communities and use such beliefs to understand their own. Cultural competence encourages people to accept differences in culture, appearance, and behavior and appreciate equality among people (Nair & Adetayo, 2019). In the healthcare sector, patients and healthcare professionals are diverse, hence the need to equip clinicians with increased cultural competence. Cultural competence is significant in the 21^st century as it enables people to interact effectively and develop better relationships with people from diverse ethnic backgrounds.

Cultural sensitivity is awareness of cultural similarities and differences among people without assigning them value. Cultural sensitivity aids in training nurses on the awareness of the nuances of cross-culture in communication (Nair & Adetayo, 2019). Healthcare professionals need to understand that they operate in an industry that houses all people from different ethnic backgrounds. Cultural sensitivity allows healthcare professionals to understand the importance of words, gestures, actions, and body language in delivering healthcare.

Healthcare leaders need to understand the above concepts as they directly affect the quality-of-service delivery. High cultural diversity skills among healthcare leaders allow them to focus on bringing change to the organization and their employees. Culturally competent leaders meet employees’ expectations, ambitions, values, and vision, which are the main ingredients for meeting the desired quality in healthcare (Kaihlanen et al., 2019). Such leaders inspire and develop the workforce to obtain a new level of performance and success because they understand the cultural behavior of diverse employees. These leaders act as examples to their subjects and are willing to see their followers outshine them in their assigned duties. Therefore, healthcare leaders can meet their healthcare goals by appreciating cultural diversity.

How Verbal and Nonverbal Communication may be Misunderstood due to Cultural Differences

The verbal and nonverbal communication may differ based on culture and country. These differences may increase the rate of misunderstanding among people from different cultures. The information passed through spoken and non-spoken words may trigger a societal misunderstanding. For instance, a word with a similar wording and a different pronunciation might mean two different things in different cultures. The difference in meaning would affect the communication between two people from different ethnic communities (Harrison et al., 2019). There is a need for people to understand the difference in verbal communication to be able to choose their words during a conversation. Again, a word that might mean happiness in one language could be an insult in another language. This diversity in language might affect the understanding of different people, and instead of them engaging in a meaningful conversation, they would think it is an insult. Therefore, it is always advisable to use an internationally acceptable language when communicating with people from diverse cultures as this would limit the chances of misunderstanding.

On the other hand, non-verbal cues such as gestures, body language, facial expressions, and eye constant might trigger different meanings in various cultures. For example, talking while maintaining eye contact with an older adult in an African setup is a sign of disrespect. A person is supposed to address the elderly while bowing and listening to all the elders have to say before reacting. However, western culture believes that eye contact is a sign that one is concentrating and grasping every detail of a conversation (Kaihlanen et al., 2019). Again, while culture might accept facial expressions for anger, happiness, sadness, and fear, not every culture appreciates facial expressions. These examples show the importance of understanding verbal and nonverbal cues in communication to reduce instances of misunderstanding in a multi-cultural environment.

The effect of misunderstanding is immense on communication in healthcare. It would result in increased disunity among healthcare professionals that affect the quality and safety of patients. Effective leadership in healthcare starts with communication (Harrison et al., 2019). The leaders should be able to communicate effectively to gain trust and confidence within their team. The improved communication also leads to better employee engagement and patient outcomes. Therefore, healthcare leaders can minimize misunderstandings by using a common language that each worker understands, appreciating the importance of cultural diversity, and inspiring followers to work in unity towards meeting the desired outcome.

Conclusion

Poor communication and collaboration are some of the main problems affecting healthcare because of the dynamic and unpredictable healthcare environment. The solution to the common communication problems affecting healthcare starts by gaining skills in cultural competence. Healthcare professionals need to appreciate that the healthcare surrounding is diverse in terms of people and language. Leading people from diverse backgrounds requires adequate cultural competence skills so that a leader would view diversity as a tool to advance healthcare outcomes.

References

Ahmed, S., Siad, F. M., Manalili, K., Lorenzetti, D. L., Barbosa, T., Lantion, V., … & Santana, M. J. (2018). How to measure cultural competence when evaluating patient-centred care: a scoping review. BMJ Open, 8(7), e021525. http://dx.doi.org/10.1136/bmjopen-2018-021525

Harrison, R., Walton, M., Chauhan, A., Manias, E., Chitkara, U., Latanik, M., & Leone, D. (2019). What is the role of cultural competence in ethnic minority consumer engagement? An analysis in community healthcare. International Journal for Equity in Health, 18(1), 1-9. https://doi.org/10.1186/s12939-019-1104-1

Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & Social Care in the Community, 26(4), 590-603. https://doi.org/10.1111/hsc.12556

Kaihlanen, A. M., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18(1), 1-9. https://doi.org/10.1186/s12912-019-0363-x

Leggett, S. A., & Price, D. M. (2020). Addressing Communication Dilemmas Through Clinical Nurse Specialist Leadership. AACN Advanced Critical Care, 31(3), 318-321. https://doi.org/10.4037/aacnacc2020503

Nair, L., & Adetayo, O. A. (2019). Cultural competence and ethnic diversity in healthcare. Plastic and Reconstructive Surgery Global Open, 7(5). https://doi.org/10.1097%2FGOX.0000000000002219

Rissel, C., Liddle, L., Ryder, C., Wilson, A., Richards, B., & Bower, M. (2022). Improving cultural competence of healthcare workers in First Nations communities: a narrative review of implemented educational interventions in 2015–20. Australian Journal of Primary Health. https://doi.org/10.1071/PY22020

Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., & Paradies, Y. (2019). The challenge of cultural competence in the workplace: perspectives of healthcare providers. BMC Health Services Research, 19(1), 1-11. https://doi.org/10.1186/s12913-019-3959-7

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AACN Advanced Critical Care Volume 31, Number 3, pp. 318-321
© 2020 AACN

Jesus Casida, PhD, RN, APN-C
Department Editor

Addressing Communication Dilemmas Through Clinical Nurse Specialist Leadership
Scherolyn A. Leggett, MSN, RN, CNS-C
Deborah M. Price, DNP, RN

oor communication and collaboration are common problems in critical care units because of the complex, dynamic, unpredictable, and time-
pressured environment. The condition of patients in critical care units is typi- cally rapidly changing, requiring clinicians to manage large amounts of data (eg, symptoms, hemodynamic and laboratory values), which must be inter- preted and effectively communicated. Critical care nurses must skillfully analyze clinical situations, make decisions based on this analysis, and rapidly intervene to ensure optimal patient outcomes.1 Complicating this response is a need for physicians to make “just in time” critical clinical decisions that are often inde- pendent of timely and effective communication.2,3 As clinical practice leaders on their units, clinical nurse specialists (CNSs) can identify and strategically address communication and collaboration issues that may be compromising the delivery of quality patient care. Through CNS leadership, interprofessional health care team members can engage in partnership activities that facilitate communication and collaboration, thus fostering a mutual respect of roles, improved patient care, and enhanced satisfaction of team members in the work environment.4-8
Using CNS core competencies of systems leadership, collaboration, and coaching, 9 the CNS can direct changes in methods of collaboration and com- munication between nursing staff and interdisciplinary health care team mem- bers. This column describes the leadership role of a coronary critical care unit (CCU) CNS in directing the implementation of effective communication and collaboration strategies between disciplines, resulting in a positive transforma- tion of unit culture.
Background
Collaborative health care is a dynamic process in which health care disciplines work together to develop the patient’s plan of care with open communication.10 This process is composed of interdependent knowledge sharing, effective com- munication, and collective decision-making.10,11 Many structural factors can influ- ence the effectiveness of communication, including professional, organizational,

Scherolyn A. Leggett is Clinical Nurse Specialist, Coronary Critical-Care Unit, University of Michigan Health System, Ann Arbor, Michigan.
Deborah M. Price is Clinical Assistant Professor, University of Michigan School of Nursing, 426 N Ingalls Street #4122, Ann Arbor, MI 48109 (debprice@umich.edu).
The authors declare no conflicts of interest. DOI: https://doi.org/10.4037/aacnacc2020503

VOLUME 31 • NUMBER 3 • FALL 2020 ISSUES IN ADVANCED PRACTICE

and educational processes.4 Challenges to communication may surface as a result of team beliefs about the traditional role of the physician as the clinical leader and decision- maker and about the paternalistic model, which reinforces that nurses are handmaid- ens to physicians.4,6,11
Perceptions by interprofessional teams of shared decision-making, teamwork, and com- munication are recurring themes in effective physician-nurse collaboration.12 Key factors for nurses that facilitate effective professional communication and collaboration include (1) having professional autonomy; (2) assuming responsibility and maintaining accountability for one’s actions; (3) preparedness and com- petence of the nurse; and (4) the presence of mutual dignity and respect.12 Studies demon- strate that nurses desire to work collabora- tively with physicians, with an exchange of knowledge, concerns, and suggestions for the patient’s plan of care.4,12 Physicians and nurses may perceive collaboration differently, so a standard operational definition must be devel- oped in order for effective communication to occur.12,13
A culture of collaboration can be promoted through relationship building (informal and formal), education of strategies for best prac- tices in communication, and techniques for managing conflict.14 Initiatives involving coach- ing strategies to improve communication have been found to be effective; these initiatives can include establishing an interprofessional journal club, incorporating morning/evening interdis- ciplinary team rounds, developing interdisci- plinary appreciation awards, and initiating deliberate physician-to-nurse bedside verbal communication to ensure nurses understand medical orders beyond what is documented in the electronic medical record.8,15

Communication and Collaboration Dilemma
The nursing and medical leadership team of a 10-bed CCU, located in a large academic Midwestern hospital setting, identified that they had an interprofessional communication and collaboration dilemma, which was foster- ing a poor unit culture. Feedback from an infor- mal survey of nurses, fellows, and residents in the CCU revealed that nurses did not feel val- ued, listened to, or taken seriously. Many of these cardiac nurses had 10 or more years of experience. Additionally, the physicians did

not feel that they could easily talk to the nurses. One physician commented, “Some of the nurses are unapproachable.” Nurses and physicians alike became aware that changes needed to occur. Staff members who took the time to identify concerns also identified solutions. When staff members were asked about the greatest opportunities to build collegiality among nurses and physicians, their responses were to have team conferences and interdisciplinary rounds. Both of these processes were in place, but this survey result afforded a chance to revisit them.

Clinical Nurse Specialist Leadership Role
The CCU CNS led the structural and pro- cess changes to be implemented. First, the CNS combined 2 existing committees into 1: the cardiology fellow–led multidisciplinary com- mittee with the CNS-led clinical quality com- mittee. Both committees had overlapping physician and nursing membership, but each lacked key multidisciplinary team players. The new committee, known as the CCU Clinical Quality Initiative (CQI),16 was composed of first-year and senior cardiology fellows, the medical and nursing directors, the CNS, the nursing supervisor, an infection control liai- son, a dietician, a physical therapist, an occu- pational therapist, a respiratory therapist, a pharmacist, and 2 staff nurses.
Within the CQI, the multidisciplinary team addresses unit-based clinical issues and hospital- acquired conditions data. The cardiology fel- low directs team discussions, and with the CNS, facilitates the group in problem-solving together. Often, the CNS will bring in experts to provide additional data with which the team can make informed decisions for prac- tice changes. For example, when catheter- associated urinary tract infection (CAUTI) rates were rising, the medical director of infection prevention and epidemiology was also invited to discuss CAUTI prevention from an expert provider’s perspective. Furthermore, when occur- rences of Clostridium difficile increased, the CNS invited a clinical epidemiologist to meet with the team. The CNS and clinical experts guide the group in understanding each disci- pline’s role and responsibilities related to address- ing the identified problems. As the clinical practice leader for the unit, the CNS identifies applicable nursing protocols and guidelines that may need to be modified or clarified for the nurses. The CQI has successfully improved

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collaboration and communication among all team members, providing each discipline with a common understanding of the unit-based prob- lems and their respective roles and responsibilities in the collaborative plan for improvement.
Beyond facilitating and leading the CQI to address unit-related problems, the CCU CNS worked with the CQI to enhance interprofes- sional communication. The CNS found that nurses and physicians had been working on methods to enhance communication but were doing this in separate silos. The CQI developed and implemented several communication strat- egies targeting improvement of the unit’s cul- ture of teamwork and collaboration, including flash rounds, night rounds, nurse-led rounds, and daily goals sheets.

Communication and Collaboration Strategies Flash Rounds
Flash rounds are a 10-minute collaboration that occurs after the daily morning team rounds. Led by the cardiology fellow, the meeting includes a multidisciplinary team consisting of a respiratory therapist, physical therapist, occupational therapist, discharge planner, social worker, dietitian, and charge nurse.
Each discipline has the opportunity to hear decisions made during rounds, ask questions, finalize details, and request physician orders be placed to move therapy forward. This has been embraced by the team, resulting in improved communication and streamlined patient care.

Night Rounds
Occurring at 10 PM each evening, night rounds are an abbreviated form of flash rounds. This conversation revisits mutually established goals of care such as clinical parameters related to evening diuresis, hemodynamics, and plans for morning extubations. Night rounds have resulted in the promotion of increased patient rest and sleep during the night, leading to a decreased risk for delirium and/or falls.

Nurse-Led Rounds
Nurse-led rounds are an evidence-based strategy derived from the awakening and breathing coordination, delirium monitoring/ management, and early mobility (ABCDEF) bundle of care, designed to promote best patient outcomes in critical care.17,18 This bundle includes the assessment of pain, breathing/

sedation, delirium, early mobility, and family engagement.17 The bedside nurse leads daily interprofessional team rounds for his or her patient, sharing the ABCDEF bundle of care information first. Cues for the ABCDEF infor- mation were placed on a 3-inch by 5-inch card that could be attached to the nurse’s badge to help prompt a comprehensive report to the team. Recently, the process of nurse-led rounds was enhanced to incorporate the daily goals sheet/poster discussed below.

Daily Goals Sheet/Poster
The daily goals sheet17-20 is a document com- pleted for each patient by the physician during morning rounds. Upon reviewing this process, the CQI identified that the form was often not completed as expected. The CQI found a more effective method of communication, a successful project in the medical intensive care unit, and adopted it for use in the CCU. The daily goals sheet was combined with nurse- led rounds and transformed into a poster that brings to life the ABCDEF bundle.17-20 The bundle assessment components have been placed on a 2-foot by 3-foot poster that is mounted on the inside of the patient’s room window, facing into the hall. The bedside nurse is able to complete the ABCDEF bundle of care information by writing with an erasable marker outside of the patient’s room. The nurse then leads the team discussion of the bundle as patient rounds occur. At the end of rounds, the fellow/intern writes the specific plan for the patient on the same document, which is reviewed and used by the nurse, respiratory therapist, physical therapist, and occupational therapist. Staff have been very satisfied in using this nurse-led rounding strategy that incorporates the ABCDEF bun- dle of care.
Conclusion
The CCU CNS established a positive CCU culture, which engaged interprofessional health care team members in partnership activities, thus improving communication and collabo- ration. Each discipline developed a mutual respect and understanding of roles and respon- sibilities, which streamlined and improved the quality of the care delivered to patients. Three years into this initiative, the CQI continues to move care delivery forward by identifying and addressing unit-based problems and improving staff relations. Clinical outcomes

VOLUME 31 • NUMBER 3 • FALL 2020 ISSUES IN ADVANCED PRACTICE

include significant decreases in catheter- associated blood stream infections, CAUTI, and fall rates. Employee engagement markers demonstrate significant improvement, as well; for example, staff willingness to recommend the CCU as a “good place to work” increased from 35% to 87%. The cardiology fellows’ per- ception of the CCU as a “good place to work” increased from 40% to 82%. The CCU, once a fragmented unit of disciplines that worked in silos, is now a thriving environment of best practices in communication, collaboration, and quality patient care delivery.

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